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Insurer to favor Kaleida program

Independent Health has named Kaleida Health's cardiac valve surgery services its first "program of excellence."

That means Independent Health will require its members who need repair or replacement of a heart valve to see a Kaleida Health surgeon first before the insurer will consider a request to obtain the procedures at hospitals in other cities.

The decision is a vote of confidence in Kaleida Health's program, although Independent Health says it applies to selected surgeons in the hospital network.

The decision also is an attempt to reduce the flow of local patients to hospitals in Cleveland, Rochester and Pittsburgh for more complex procedures, a trend that makes it more difficult to support programs here.

"There is no reason to go out of town if they are providing quality care. They have made changes, and we've tracked their data. They have two to three surgeons with good results," said Dr. John Gillespie, chief medical director at Independent Health.

Gillespie said Kaleida Health improved its heart surgery program in recent years to obtain results above the average for hospitals in the state; it also has broadened its capabilities to do more valve repairs rather than replacements, which can require patients to take risky blood thinners.

Good programs focus on such criteria as a team approach, dedicated anesthesia teams, standard operating room protocols and common equipment.

"Because of the higher costs associated with out-of-area care for the member and the plan, we believe patients can receive the same quality at greater value by remaining in-network when appropriate," Gillespie said.

He said the insurer will consider requests for out-of-town referrals on a case-by-case basis.

For Kaleida Health, which offers heart procedures in its Buffalo General and Millard Fillmore hospitals, Independent Health's action reflects serious efforts to improve a program that was not achieving top-notch results three years ago, said Dr. M. Hashmat Ashraf, chief of cardiothoracic surgery.

"There is a perception that we are not as good as Cleveland and that we don't really do repairs," he said. "But we've shown that we have the results, that they are not a fluke and that we have had the capabilities. Hopefully, this will percolate into the community."

Independent Health intends to expand its "Programs of Excellence" to other specialties and procedures, such as orthopedics and coronary-artery bypass surgery, Gillespie said.

It aims to recognize leading area physicians and hospitals to promote the availability of quality services in the Buffalo area, officials said.


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